فصلنامه پژوهش های سلامت محور
سال چهارم شماره 1 (پیاپی 12، بهار 1397)

Tuberculosis is a chronic bacterial disease that can be transmitted from the affected persons to others through air when the airway and lung drops of patients are released in the air and inhalled by healthy ones. This disease has a high prevalence in Zabol/ Iran due to the drought, rainfall status, high temperature, severe storms and dusty condition in this region. This descriptive-analytical research was conducted from June 2005 to June 2015 using weather data and the 10-year statistics of tuberculosis patients in Zabol city, of whom 62 patients had been treated. A researcher-made questionnaire was used to identify the factors affecting the disease. Data analysis was done through SPSS22 software and using Pearson correlation and regression analyses. Climatological data showed increasing rate of wind speed over the past ten years. There was a negative correlation between the prevalence of tuberculosis and mean of annual rainfall during the ten years (P≤0.014). The results of regression test showed that wind speed had been very effective in the prevalence of tuberculosis (P = 0.711). To control tuberculosis, regular periodic screening, continuous education and more serious plans for providing specialized care and services are recommended. Meanwhile, appropriate measures including mulching and increasing plant coverage of the region should be taken to control dust.   Key words: Tuberculosis, Drought, Dust, Weather station, Zabol city   Citation: Malakootian M, Mish MastNehi M. A study on the Effect of Draught and Dust Amount on the Prevalence of Tuberculosis in Zabol City. Journal of Health Based Research 2018; 4(1): 1-11.

Patient satisfaction is a key hospital quality and effectiveness indicator. Strategic planning is necessary for hospitals to respond to the rapidly changing internal and external environments, to provide quality services, to maximize revenues and to minimize costs. This study aimed to examine the impact of strategic planning on patient satisfaction in a hospital. A participatory action research was conducted in a private hospital during the period 2012-2014. Hospital strategic plan was developed and implemented. A goal for enhancing patients’ satisfaction was determined in the strategic plan. Structural, procedural and cultural interventions were applied to improve patient satisfaction. Patient satisfaction was measured before and after implementing the strategic plan via a valid and reliable questionnaire. Data was analyzed using the SPSS software. The quality of inpatient services and outpatient services were increased 6% and 8.6% respectively. Accordingly, inpatient satisfaction has increased from 77.4% in 2012 to 83.8% in 2014 (a growth of 8.3%). Out patient satisfaction has increased from 71.6% to 88.8% (a growth of 24%) during the same time period. Outpatients’ waiting time has declined by 33%. Improving quality of services and patient satisfaction enhanced inpatients’ and outpatients’ loyalty by 20% and 87% respectively. Developing an appropriate strategic plan, promoting a collaborative and cooperative culture, empowering employees, expanding organizational resources and implementing the strategic plan appropriately improve patient satisfaction and enhance their loyalty.   Key words: Strategic planning, Inpatients satisfaction, Outpatients satisfaction, Private hospital, case study, Participatory action research   Citation: Mosadeghrad AM, Ebneshahidi A, Abdolmohammadi N. The Impact of Strategic Planning on Patient Satisfaction: a case study. Journal of Health Based Research 2018; 4(1): 13-29.

Establishment of a “referral system” in Family Physician plan has been recommended by WHO, in order to better respond to population health needs and achieving the goals of health system. This study aimed to analyze the family physician plan and referral system in Iran and to provide a number of recommendations for improvement of this plan. This study was a retrospective policy analysis study which was conducted based on the Walt and Gilson's policy analysis triangle framework. In order to analyze the Family Physician plan and referral system in Iran various methods including documentary analysis and reviewing the existing evidence were applied. Then, a qualitative study based on a phenomenology approach was used through semi-structured interviews with 6 experts in order to validate the earlier findings.   The results of this study showed that the performance of most actors who were involved in the establishment and implementation of the Family Physician plan had not improved this plan. Other important challenges that have been identified in terms of content, context, and process were lack of priority setting in objectives of this policy, frequent changes of decision-makers, impetuosity in implementation without careful planning, multiplicity of insurance systems, and poor quality of feedback.  Improvement of the position of family physician and referral system and advertising the advantages of this plan through public media, establishment of electronic health records for patients, providing required education in the curriculum of general medicine as well as considering the interests of all stakeholders would significantly help in successful implementation of this plan in the country.   Key words: Analysis of policy, Case study, Referral system, Family physician, Health system, Iran   Citation: Mehtarpour M, Tajvar M. Policy Analysis of Family Physician Plan and Referral System in Iran Using Policy Analysis Triangle Framework. Journal of Health Based Research 2018; 4(1): 31-49.

Due to the lack of evidence about the most cost-effective thrombolytic drug in the treatment of acute myocardial infarction with the ascension of the ST segment, this study was conducted to evaluate the cost effectiveness of tenecteplase, as a new medicine, versus Reteplase in the treatment of acute myocardial infarction patients with the ascension of the ST segment in Iran. This study was a type of health technology assessment study. We searched the MEDLINE, Cochrane Library (DARE-EED-HTA, Web of Science and EMBASE databases (from March1980 to March 2017) by using related keywords for finding cost-effectiveness, safety and economic studies. The qualities of studies were independently assessed by STROBE checklist and data were extracted using Cochrane data extraction form.   Three studies were eligible for inclusion and all three were of high quality. Mortality had been compared between Tenecteplase and Reteplase. The results of two studies with 781 samples had showed the same efficacy for Tenecteplase and Reteplase in regard to mortality rate. According to the cost-effectiveness analysis, Reteplase is more cost effective than TNK-ase (250 $ versus 537.49 $). Reteplase, due to the same safety and effictiveness but lower cost, is preferred to Tenecteplase and considering the current economic conditions of Iran, it is recommended to be used in the treatment of acute myocardial infarction patients with the ascension of the ST segment.   Key words: Health Technology Assessment, Acute Myocardial Infarction, Tenecteplase, Reteplase, Economic evaluation   Citation: Bashzar S, Tourani S, Nikfar S, Ravaghi H, Habibi M. Health Technology Assessment  of TNK-ase vs. Reteplase in the Treatment of Acute Myocardial Infarction in Iran. Journal of Health Based Research 2018; 4(1): 51-62.

Correct relationship between nurses and patients will improve the therapeutic outcomes and improve the patient's recovery process. One of the most important items in improving communication skills, as an essential part of providing nursing services, is the attitude and feedback of nurse to various phenomena and to create the necessary internal preparation for making positive changes in cognitive domain. This study aimed to investigate the effect of participatory teaching of positive thinking skills on communication skills of nurses in the emergency department of a selected hospital in Kerman city. This analytical study was an interventional study and it was conducted on 60 nurses at the selected educational hospital divided into the two groups of experimental and Control. Queendom Communication Skills Questionnaire was used for data collection. The experimental group received positive thinking skills education during 9 sessions. Independent t-test, ANOVA and single-variable covariance analysis test were used for data analysis. Data were entered into SPSS version 22. Mean of total score of communication skills increased in the experimental group. Based on the post-test results, there was a significant improvement in the mean scores of listening skills, the ability to receive and send messages, emotional control, connection with decisiveness and insight into the communication process of nurses  based on their group (P <0.05). Considering the effectiveness of teaching positive thinking skills in increasing nurses' communication skills, it is recommended to provide training for these skills from the beginning of nursing students’ education.   Key words: Participatory Education, Positive Thinking Skills, Communication Skills, Nurses, Emergency Department, Teaching Hospital     Citation: Salehi S, Hashemi F, Avaznejad N, Karami Robati F. The Effect of Participatory Teaching of Positive Thinking Skills on Nurses Communication Skills in the Emergency Department of a Teaching Hospital. Journal of Health Based Research 2018; 4(1): 63-76.

The available reports indicate that outsourcing strategy was not successful in hospitals affiliated with Tehran University of Medical Sciences. The present study aimed to identify the reasons behind the failure of this strategy and also to provide solution to overcome the challenges.  The present study was a phenomenological qualitative study conducted in 10 hospitals with outsourcing units affiliated with Tehran University of Medical Sciences. Data were collected through 32 semi-structured interviews with key informants and were analyzed using content analysis approach and through MAXQDA11 software. In this study, 4 main codes (reasons related to hospital, private sector, finance& expenses and human resource) and 18 sub-codes were identified for challenges of outsourcing in hospitals. Also, 3 main cods (preparation, implementation, control and monitoring) and 11 sub-codes were identified for the improvement of the outsourcing strategy. The Ministry of Health, as the main custodian of public health, should improve its capacities to increase the efficiency of private sector and consider a specific place for private-public partnership strategies, in its future policies. This requires clarifying concepts, revising job descriptions, and clarifying the roles of different individuals in the process of outsourcing.   Key words: Outsourcing, Challenges, Solution, Hospitals, Tehran University of Medical Sciences   Citation: Ahmadizadeh E, Tajvar M, Ahmadi A, Ahmadi B. Challenges of Outsourcing in Hospitals Affiliated with Tehran University of Medical Sciences and Suggested Solutions. Journal of Health Based Research 2018; 4(1): 77-93.

Background & Objectives: The combination and distribution of human resources is one of the major factors affecting the quality, quantity, cost, and speed of provision of health services. Today, one of the most important problems of human health systems is the inappropriate distribution of human resources. The aim of this study was to investigate the ratio of human resources to the amount of services provided in hospitals affiliated to Kerman University of Medical Sciences. This descriptive cross-sectional study was conducted during March 2015 to February 2016, to review the occupational categories of nursing staff, midwife, patient carrier, and unit secretary in 10 teaching and non-teaching hospitals in Kerman province using three methods of Workload Indicators of Staffing Need (WISN), systematic approach, and bed occupancy rate (BOR). Data were collected using a form contains job descriptions, the quantity of services provided per year by the occupational categories studied, the standard of activity time, the work time available to the hospital staff, and bed occupancy rate in the units studied.. The systematic approach showed the highest need for human resources, and then, the bed occupancy ratio and WISN respectively showed the highest need, which however, depended on the hospital unit. So that, in calculating the required number of nurses in the intensive care and burn units, the index proposed by the Ministry of Health in bed occupancy rate was higher than the WISN, and the index obtained in the emergency department, was higher than the WISN. It is suggested to replace traditional methods with modern human resources estimation systems, as WISN. Also, it is recommended to measure the time and activities of hospital units to determine the ratio of staff to bed for each hospital.

Background & Objectives: According to the government policies, universities are suggested to change their budgeting system from a programming budgeting system to the performance-based one. This study was conducted to investigate the feasibility of implementation of the performance-based budgeting system in Iran University of Medical Sciences. This cross-sectional descriptive-analytic study was conducted in 2018. The statistical population of the study was all 108 financial staff, budget experts, and accounting experts of Iran University of Medical Sciences and subsidiary colleges. A researcher-made questionnaire with dimensions of ability, discretion, and acceptance was used to collect data. Data were analyzed using Pearson's correlation coefficient by SPSS version 20 software. For implementing performance-based budgeting system, all three criteria (ability, discretion, and acceptance) were at the moderate level. There was an inverse and significant correlation between acceptance variable and age of respondents. There was also an inverse and significant relationship between motivational acceptance variable, age and work experience of respondents (P<0.05). Implementation of performance-based budgeting in Iran University of Medical Sciences requires development of the expertise and skill required to calculate the cost of services provided, standardization of the internal and external organizational procedures, and creating motivations and incentives to start and implement the performance-based budgeting process appropriately.